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We thank Dr Akioka for the comments1 on our recent study on the bivalent human papillomavirus (HPV) vaccine in patients with juvenile idiopathic arthritis (JIA).2 Akioka and coworkers describe a patient with enthesitis-related JIA after receiving the bivalent HPV vaccine. It was unclear whether this patient newly developed JIA or experienced a flare of pre-existing JIA.
With regard to the former, vaccinations are indeed often described as potential environmental triggers inducing autoimmune diseases in genetically susceptible individuals.3 ,4 For example, cases of systemic lupus erythematosus have been described after the quadrivalent HPV vaccine.5 However, in a large register-based cohort study, including 997 585 girls among whom 296 826 received a total of 696 420 quadrivalent HPV vaccine doses, no association between exposure to the quadrivalent HPV vaccine and autoimmune adverse events was found.6 Thus, large controlled studies often do not support a relation between vaccinations and the induction of autoimmune …
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